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Background Intra-articular injections have diagnostic and therapeutic roles in foot and ankle pathologies due to complex anatomy, small size, diverse bones, and joints with proximity in this region. Conventionally, these injections are carried out using anatomical landmark technique and/or fluoroscopic guidance. The small joint space and needle size make the injection challenging. Fluoroscopy is not readily available in the clinical setting; ultrasound-guidance for injections is therefore increasingly being used. We compared the accuracy of intra-articular talonavicular injections using the anatomical landmark technique versus the ultrasound-guided method. Purpose To determine whether ultrasound guidance yields superior results in intra-articular injections of the talonavicular joint compared to injections using palpatory method guided by anatomical landmarks. Material and Methods The feet of 10 cadaveric specimens were held in neutral position by an assistant while a fellowship-trained foot-ankle orthopedic surgeon injected 2 cc of radiopaque dye using anatomical landmarks and palpation method in five specimens and under ultrasound guidance in the remaining five. The needles were left in situ in all specimens and their placement was confirmed fluoroscopically. Results In all five specimens injected under ultrasound guidance, the needle was found to be in the joint, whereas all five injected by palpation only were out of the joint, with one in the naviculo-cuneiform joint, showing ultrasound guidance to significantly increase the accuracy of intra-articular injections in the talonavicular joint than palpatory method alone. Conclusion Ultrasound-guided injections not only confirm correct needle placement, but also delineate any tendon and/or joint pathology simultaneously.

Schwannomas are rare, benign tumors originating in the Schwann cells of the peripheral nervous system. They are most commonly found in the head, neck, and upper extremities, which involve the spinal nerves of the brachial plexus. However, schwannomas of the lower extremities are extremely uncommon, and few studies have reported a schwannoma originating from the posterior tibial nerve. We report on a case of a 71-year old male who presented to our clinic because of left foot and ankle neuritic pain. A nerve tumor was found; subsequently, the tumor was surgically excised along with the release of the tarsal tunnel.

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Category: Arthroscopy, Basic Sciences/Biologics, Midfoot/Forefoot Introduction/Purpose: First metatarsophalangeal (MTP) joint fusion has been proven to be an effective treatment for a variety of conditions such as osteoarthritis, rheumatoid arthritis, hallux rigidus/valgus, and failed first MTP arthroplasties. Multiple surgical techniques have been described in the literature with regards to bone preparation and different fixation with varying degrees of success. Studies have demonstrated that one of the complications of MTP fusion is first ray shortening, which can lead to symptomatic forefoot disorders such as transfer metatarsalgia of the lesser toes. Patients can develop altered gait mechanics that manifest as decreased ankle plantarflexion at toe-off and decreased step gait. The purpose of this study was to compare the amount of first ray shortening that occurs during MTP fusions with open versus arthroscopic technique. Methods: Ten specimens were divided into two groups. Group one was arthroscopic and group two was open technique. For arthroscopy, the long extensor (EHL) tendon and first MTP joint were identified. Dorsomedial and dorsolateral ports were created at the level of the MTP joint. A small curette was used to prepare the joint. For open technique, an incision was made on the dorsum of the first MTP joint and carried down to the subcutaneous tissue. The EHL tendon was dissected and a capsulotomy was performed. The head of the first metatarsal and the base of the proximal phalanx were exposed. Dome-shaped reamers were used to prepare the joint. A lag screw was used for fixation. AP and lateral radiographs were obtained. The length of the first ray was measured from the base of the first metatarsal to the distal end of the proximal phalanx. Pre and post fixation lengths were compared. Results: A comparison of pre and post fixation first ray length demonstrated that there was an average decrease of 2.2 mm in the arthroscopic group and 2.1 mm in the open technique group. Even though both techniques shortened the average length of the first ray, there was no statistically significant difference between the groups (p = 0.934). Comparison of the average percentage of surface area prepared of the head of the first metatarsal showed a statistically significant difference (p = 0.035) between both techniques. In contrast, comparison of the average percentage of surface area prepared of the base of the proximal phalanx and total surface area prepared did not show a statistically significant difference (p = 0.159 and p = 0.051) between the groups. Conclusion: First metatarsophalangeal (MTP) joint fusion has been proven to be an effective treatment for a variety of conditions that affect the first ray. First ray shortening can lead to symptomatic forefoot disorders and altered gait patterns. The results of our study indicate that there is no statistically significant difference in first ray length after MTP fusion performed by either arthroscopic or open technique. Our study also showed that even though the average percentage of surface area prepared of the head of the first metatarsal was statistically different between both groups the average percentage of total surface area prepared was not.

This study compares the amount of joint preparation and first ray shortening following first metatarsophalangeal (MTP) joint fusion utilizing open conical reaming versus arthroscopic technique. Methods Ten below-knee cadaver specimens were randomly assigned to undergo either open or arthroscopic first MTP fusion. Following fixation, first ray length measurements were obtained from pre-operative and post-operative radiographs and were used to determine first ray shortening. Additionally, the ratio of first ray length to second ray length was calculated both pre-operatively and post-operatively and compared between the two approaches. All ankles were then completely dissected, and prepared surface areas were demarcated. ImageJ photo analysis software (National Institutes of Health, Bethesda, MD, USA) was used to calculate the percentage of prepared and unprepared cartilage of each articular surface of each specimen. Results Overall, the open approach resulted in 99.3% ± 1.6% joint surface preparation, whereas the arthroscopic approach yielded 92.9% ± 7.2% (p = 0.089). On average, the head of the first metatarsal was significantly more prepared with the use of the open approach (99.5% ± 1.1%) than with the arthroscopic approach (96.6% ± 1.5%) (p = 0.008). However, with respect to the base of the phalanx, the average difference in preparation between the arthroscopic approach and the open approach was not statistically significant (90.0% ± 12.8% vs. 99.0% ± 2.2%; p = 0.160). The average amount of first ray shortening in the arthroscopic approach was 2.2 ± 1.8 mm compared to 2.1 ± 3.2 mm in the open approach (p = 0.934). The average change in the first to second ray length ratio was 0.02 for both approaches (p = 0.891).